California In-Home Operations Waiver

California’s In-Home Operations (IHO) Waiver allows services to be given to Medi-Cal recipients in their home or in a community setting. It is a good alternative to living in a nursing facility.

Key Stats:

Income Limits (Individual)

$16,612

 

Income Limits (Couple)

$22,490

 

Asset Limits (Individual)

$2,000

Asset Limits (Couple)

$3,000

Enrollment Limit

125

Contacts:

IHO Waiver Participant Contact Hotline

(916) 552-9214

Related:

What is a Medicaid Waiver?

Who is this program for?

The In-Home Operations waiver is for people of all ages who are Medi-Cal eligible. Medi-Cal is California’s version of Medicare. The patient can be medically fragile or dependent on some type of technology to receive the waiver. By receiving the In-Home Operations Waiver, the participant can live in their own home and receive services from the California Department of Social Services.

Benefits & Services

For individuals of all ages, this waiver can dramatically alter their lives in a positive manner. There are a multitude of services that one can receive with the In-Home Operations Waiver.

Home Health Aide Services

Duty Nurse services or certified home health aides provide service on a regular schedule in the patient’s home or home-like residence. All the information about the type of care the patient should receive is in their Plan of Care.

Personal Emergency Response System

The Personal Emergency Response System is a device used to alert help in case of an emergency. The Installation and Testing benefit allows for the patient to have the device installed as well as tested.

Medical Equipment

This service is available for waiver participants to use for the required medical equipment to survive. It prevents the patient from staying in a nursing facility as medical technology can be used at home. Indicating expenses for the medical equipment must be on the patient’s plan of care as a necessity.

Caregiver Training

This benefit allows for family members or caregivers to receive counseling or training in regards to caring for their loved one. Some of the training consists of how to use the medical equipment that the patient requires or what special diet should the patient eat. A registered nurse gives the training, so if you have any questions, they can be answered on the spot. Counseling is also provided within this waiver service. The responsibility of caring for someone full time can be tough. Therapists or counselors can help ease the frustrations that come with the job.

Environmental Accessibility Adaptations

Environmental Accessibility Adaptations encompass the necessary changes to the patient’s home for them to live comfortably. The best way to think of this is that if the patient didn’t have specific changes to their living space, they would have to be in a nursing facility full-time. Therefore, they may have their doorways extended for a wheelchair or the bathroom facilities updated, for instance.

Community Transition Services

The Community Transition Service is a benefit that most likely occurs once in the participant’s life. It helps with transitioning a patient who was living in a nursing facility to residing on their own. The patient will be in complete control of making decisions or caring for themselves. While they will have assistance, it is a significant change from being cared for 24/7 in a nursing facility. Transitions service helps the individual ease into the process.

Personal Care Services

Waiver Personal Care Services (WPCS) is offered to enhance the patient’s independence in their daily activities as well as promote socialization. Most often, due to their disability, waiver recipients tend to have an issue being a self-advocate or thriving socially. The WPCS can help with both.

Respite Care

To give relief to the caregiver of the patient, Respite service is offered. While Respite may not exceed 24 hours, this service is offered to provide the caregiver a break from the constant care of the waiver participant. The person charged with delivering the Respite will care for the patient, medically and personally, in the caregiver’s absence.

Residential Habilitation Training Services

Habilitation services are given to the patient in their home or while in the community. The service allows the waiver recipient to get assistance with skills necessary to live in their home environment or participate in community activities. Habilitation includes some of the following: personal skills development, conflict resolution, community participation, development of personal habits, and daily living skills (cooking, cleaning, shopping). This service encompasses the needs required by a patient that goes beyond medical help.

Case Management

The primary purpose of the Case Management service is to evaluate the patient and then determine what services they require within their home. The Case Manager is also in charge of finding the correct personnel to assist the patient with the care that they need. Working with the patient, their family, and doctor, the Case Manager will determine a plan of care that best suits the individual. Also, they make sure that the patient is receiving their planned services by checking in with the family from time to time. Case Management is a valuable service to have as it makes sure all of the moving parts are running smoothly.

Eligibility Requirements

To qualify for the In-Home Operations Waiver, the patient can be a Social Security Income (SSI) recipient, Optional State supplement recipient, or aged or disabled patients with income beneath 133% of the federal poverty level. The waiver recipient must require medical services in order to thrive.

In general, the IHO waiver is available for:

  1. People who have been enrolled in a In-Home Operations waiver prior to January 1, 2002 without stopping waiver participation, and require medical services provided by a licensed nurse; or
  2. Those who have been receiving continuous care in a hospital for 36 months or greater and have physician-ordered direct care services that are greater than those available in the NF/AH Waiver for the participant’s assessed level of care.

If you’re loved one falls in these categories, they are eligible for the waiver.

How to Apply

  • The legal representative of the patient must contact IHO and Request an HCBS Waiver application. The email address is IHOwaiver@dhcs.ca.gov. The numbers are:
    • Northern California (916) 552-9105
    • Southern California (213) 897-6774
  • Once the form is complete, a social worker will come out to the home of the patient to perform an assessment. They will tell you what services you can qualify for as well as how many hours the waiver will cover.
  • The county must receive a completed Healthcare Certification before service can begin.
  • You will be notified if your loved one has been deemed eligible or ineligible. If the patient did not obtain the services of the waiver, the reasoning would be included in the letter.
  • The state can refuse acceptance of the waiver even if the patient seems completely eligible by all other standards. There is a cost limit that can occur. When the state determines that the cost of the home and community-based services provided to the individual would exceed their level of care costs, declining eligibility could take place. The patient’s level of care at the time of enrollment determines how much the state will pay for services. If the patient and/or their support system doesn’t agree with the state, they will not be eligible for the waiver.
  • The waiver serves about a hundred patients each year. After the number is reached, a waiting list will commence. Waiver capacity is managed on a statewide level.
  • If your family member is approved, then the services and number of hours will be listed on the document.
  • The first item for the patient to complete will be to identify a group of supporters. This support system could be anyone reliable such as a doctor, a family member, or community-based organizations. This is so if the authorized waiver provider cannot perform services, the support system steps in to help.
What’s next?

You will have to hire a provider to perform the needed services decided by the social worker. Check with your county as some of the rules vary.

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